Where to begin and how to practice yoga as you get older including general points on ageing, some risk factors, osteoporosis, balance, back pain, sciatica, joint pain, metabolism and the efficacy of Pilates.
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From the article by Dr Loren Fishman, New York Times – 8th May 2013. Loren Fishman, MD is Medical Director of Manhattan Physical Medicine and Rehabilitation in New York City, author of seven books, author or editor of more than 70 academic articles, and a world-recognized pioneer in the treatment of piriformis syndrome and rotator cuff tear, for which he has developed non-surgical interventions. His ability to diagnose and cure all types of back pain has earned him wide acclaim. Dr. Fishman has applied yoga to the treatment of sciatica, scoliosis, rotator cuff syndrome, multiple sclerosis, osteoarthritis, osteoporosis, and shoulder pain. He has studied in Pune with BKS Iyengar.
To find an Iyengar Yoga teacher, see http://www.iyengaryoga.org.uk and use the search box. If you have a particular problem that requires remedial treatment, find a Senior Teacher for advice before proceeding.
Q. What is the best way to begin or to resume yoga when you are over 50?
A. First, find out what your limitations are. This depends on the individual and might require a medical visit. The next step is to find an experienced and well-trained yoga teacher for a one-to-one class and assessment. Group classes came about through urban economics: many yoga teachers cannot afford to teach small numbers. But because chronic conditions are cumulative, when you’re older you need the individual attention that yoga has traditionally offered.
There are many other types of yoga, but the teachings of B.K.S. Iyengar are the most anatomically sophisticated and therapeutically oriented. (Iyengar Yoga Teachers trained to Intermediate Junior Level 3 are insured for one-to-one classes.) You will need a resourceful and sensitive teacher to assess your capabilities and to introduce you to an appropriate yoga practice that you can do every day. After six to eight weeks you should go back to your teacher for a re-assessment and suggestions about how to progress to the next stage. Your teacher will also be able to tell you when you are ready to join group classes, if you wish to do so.
Yoga, practiced consistently, does good things to your temperament and perceptions. You will find that after a period of six weeks’ regular practice, your views as well as your body will have changed. This is a good time to have another one-to-one session.
Q. Are there any aspects to yoga practice that the over-50 practitioner should give up if she/he is healthy and otherwise feeling well? How about after 70? What poses cause the most injuries, and which might help protect or rehabilitate common yoga-associated injuries?
A. Yes, there are things you may need to give up in your yoga practice as you get older. People age differently, and yet there are characteristic aspects to aging. Chronic conditions are cumulative. With osteoporosis you can do forward bends to as far as your hips will carry you without pushing, keeping your back slightly concave if possible, and preventing it from slouching forward no matter what. (See http://sciatica.org/yoga/12poses.html)
Beware taking the avoidance of forward bends to phobic extremes, however: good posture and sensible bending and lifting is an antidote to osteoporotic fractures; flexibility, coordination, balance and strength are the best prevention of hip fractures. Standing poses like Vrksasana (the tree), Virabhadrasana I, II and III (the warrior poses), and Ardha Chandrasana (half-moon pose) promote these positive traits and are some of the last poses one should give up as one ages.
Arthritis will respond to yoga. Supta Padangusthasana is as safe and as good as a pose gets, and will help with safe forward bending, too, by lengthening the hamstrings and stretching the hips’ capsule. We will come to many more suggestions and caveats in the questions and answers that follow.
Q. Any age-related additional risk factors with respect to the vertebral artery during Sarvangasana (shoulder stand) and Halasana (plough pose)?
Q. I am 55 and began yoga two months ago. I go every other day, but I still have problems with the balance poses. I did not have these issues in my youth. Is it typical to have more balance issues as you get older?
A. Most arteries become more brittle and are more easily injured, just as the skin gets more delicate with age. Sarvangasana (shoulder stand) and Halasana (plough pose), and poses like Parighasana (the gate) should be trimmed back from their extremes for safety after the age of 70. Ask your teacher for guidance.
The vertebral artery actually figures in nourishing a number of neurological structures critical to good balance and coordination, so it is worth taking great care of it. The three determinants of balance are the inner ears, proprioception (lowered awareness of position and relative location of parts of the body) and vision, and our sense of balance can also be degraded with age:
- Decreased sensitivity in the semicircular canals (in the ears) to changes in direction and momentum.
- Decreased proprioception in the joints and in one’s feet.
- Less acute vision.
Do the precarious poses against or very close to a wall. The wall is a wonderful, supportive teacher and use a chair on your mat, so it won’t move away from you!
BACK PAIN AND SCIATICA
Dr Loren Fishman and his colleagues discuss back pain more fully on their excellent web site www.Sciatica.org. See also the book he wrote with Carol Ardman, “Yoga for Back Pain”, showing many poses modified for those in pain or unable to do the full pose. There are chapters on herniated disc, spinal stenosis, and how to tell the difference between the two. Yoga with physical therapy is an excellent choice for someone with either a herniated disc or spinal stenosis. But first, get a proper diagnosis.
Q. I am 48, in good shape cardiovascular-wise (runner), and decided to try yoga recently. All went well initially but of late I have had considerable back pain both when sitting and lying flat. Could I have an injury? If it’s just sore muscles, will it eventually get better if I keep doing it?
A. First, much back pain is discovered in yoga class but really has its origins elsewhere. Second, yoga can cause back pain, and then, as always, the question is: what is the diagnosis? Pain is a symptom, not a disease. Without a diagnosis you’re left to guess about proper treatment, for the same pain can have causes so different that treatments are diametrically opposite.
One way to decide if it’s sore muscles or a neurological injury is if the pain goes down one or both legs, or radiates. Does anything tingle; is some part of your leg numb? If so, it’s nerve pain, indicating an injury that merits further inquiry. If not, it’s probably a muscle spasm or strain, and stretching should make it feel better – I say ‘probably’ because someone could also have a spinal fracture, facet arthritis, spondylolysis or other problem. The bottom line is that you need a diagnosis before yoga or anything else can be used to help treat the problem.
Q. I have sciatica and a herniated disc so bad I want to cry. I’m on prescription pain killers but I’d rather be better and not drugged up. Will yoga help sciatica?
A. Sciatica is nerve pain that goes down the leg along the course of the sciatic nerve. It can be helped with yoga, but it must be done with extreme care.
- A herniated disc responds to extension, and may be worsened by flexion.
- Spinal stenosis improves with flexion, and is exacerbated by extension.
- Yet both can cause sciatica, and the same exact distribution of numbness, weakness and pain.
- About 5 percent of the time, the treatments reverse: extension helps stenosis, flexion is good for herniated discs.
- Start tentatively, be sensitive to the changes you feel, and progress slowly.
Q. At a healthy 61, I took up Iyengar yoga last year with an experienced teacher and felt better and limber than I had in my whole life. Six months later, I experienced low back pain and sciatica. I have a L4-5 and L5 – S1 disk bulge. I had physical therapy and two epidural steroid injections. The pain and numbness is only marginally better and has kept me from yoga, which I miss greatly. I don’t think I overdid yoga. My doctors think I will recover slowly. Is there remedial yoga for sciatica, and what is the best way to get back to yoga once I am better?
A. Back bends will very likely help in this case. Find one of the excellent Iyengar teachers in your area and you will likely benefit from Salabasana (the locust), Setubhanda (the bridge) and Ustrasana (the camel), among others. Again, progress slowly.
JOINT PAIN AND METABOLISM
Q. I am 58 and a breast cancer survivor. I have been doing vinyasa yoga for about five years. In the last two years, I have had problems with my sacroliliac joint and I understand this may be the result of too much flexibility in the hip joint. In addition, I am interested in whether yoga can slow the metabolism. I would greatly appreciate advice on protecting the sacroiliac and whether the metabolism issue is a myth.
A. People often ask about sacroiliac joint pain. For those with this problem, I describe some unusual but easy versions of difficult poses, like the two-armed support in Pinca Mayurasana (the peacock), in the new edition of “Yoga for Back Pain,” which I wrote with Carol Ardman. Also helpful is Gharudasana (the eagle), Ghomukhasana (the cow), and “leaning” as described in my earlier book, “Low Back Pain.”
Several people have asked whether yoga slows metabolism. Yes, it does. It lowers blood pressure and reduces atrial fibrillation and in general calms things down. But that does not mean yoga cannot be used to trim your weight. Yoga does it differently, by stretching the organ, the stomach, which will then send turn-off signals to the appetite centres in the brain. Poses like Virabhadrasana III (the warrior III), Parivrtta Janu Sirsasana (the twisted janu sirsasana), and Parivrtta Parsvakonasana, done 10 to 20 minutes before a meal, will probably work. This requires a small amount of self-discipline, but then again, so does just about anything that succeeds.
Q. I had disk surgery in the 1990s and sciatica has returned. I have tried interventions to avoid additional surgery. I was told, however, to stop yoga and continue with Pilates on the reformer. I stretch my hamstrings and do a few poses daily after a hot shower. I walk a lot but want to maintain my upper body strength. What are your thoughts?
A. If sciatica has returned after an initial surgery, I would not confine myself to Pilates on the reformer. Pilates is good for the healthy, and there are people who describe themselves as Pilates therapists, applying and modifying Pilates practices to form a healing regimen. Still, I have not encountered the type of rigorous scientific work, nor the careful study of therapeutic benefit that you find in yoga. Instead of Pilates, I would do gentle yoga, restorative yoga, lift weights while lying down on your back (taking all weight off the discs) and continue walking a lot.
Q. Can yoga help in dealing with sciatic pain? Are there particular poses that can relieve sciatica?
A. First find the cause of your sciatica, then consider the suggestions given in the answer above.
Q. I have sciatica and also a herniated disc. I used to practice yoga years ago on a daily basis until my back started to bother me. I cannot do any forward or backward bends at all. I miss the yoga postures and how limber it made me feel. Are there any yoga postures that people with back problems can do?
In cases of sciatica with a herniated disk:
- Avoid either forward or backward bends.
- However, you can do sideways poses like Vasisthasana (side plank – LOY p.309-3011), which we have shown with M.R.I.s to reduce stenosis and herniated discs.
- Also, beware of pushing too hard; consider trying the poses that used to make you feel good — but only 10 percent of the way — until you feel stronger.
- Start back bends very slowly. Self-pacing is a critical part of any self-discipline, and applies to all parts of yoga, from beginning to end.
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